Title

Author

Date

October 2007

Document Type

Dissertation

Degree Name

Ph.D.

Institution

Oregon Health & Science University

Abstract

Comfort has long been recognized as an important nursing outcome. The environment in which health care is delivered can affect patientsâ perceptions of comfort. Despite increasingly popular alternatives to expensive hospital care, such as home hospital, little is known about patient perceptions of comfort in the home hospital model. This exploratory, descriptive study used a qualitative as well as quantitative approach to study older adult perceptions of comfort in a home hospital (HH) model of care compared to traditional hospitalization (TH.) Purposive sampling included 15 hospitalized patients and 15 home hospital patients. Diagnoses included were 4 chronic heart failure, 4 community acquired pneumonia, 4 chronic obstructive pulmonary disease and 3 cellulitis patients in each group. Interviews were conducted using semi-structured, open-ended questions and a General Comfort Questionnaire (GCQ) was administered to each participant. Qualitative analysis in the form of qualitative description was used to describe patient perceptions of comfort and identify common themes of comfort detractors and enhancers in the HH and the TH environments. Scores from the GCQ were used to stratify and further analyze the qualitative data. As previous studies on comfort have identified, perceptions of comfort emerged as a highly individualized and state specific. Conditions that were perceived to enhance comfort for some, detracted from comfort for others. Nevertheless, the major finding was that both the home hospital and traditional hospital groups reported they were comfortable in their respective environments. Being where they thought they needed to be and having their needs met in the respective environments affected self reports of comfort. Two reasons for choosing TH as opposed HH that were independent of the acute medical need emerged in the qualitative data; social fulfillment and caregiver respite. These findings indicate that nursing assessment of social and caregiver needs when determining whether HH is the right environment for some patients may be appropriate. Additional study examining the social and caregiver needs of potential HH patients is needed.

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